GHS Department of Family Medicine Overview of Physician Compensation Plans Sean T. Bryan, MD, FAAFP Susan Mullinax, MBA Chair, University Medical Group Board of Directors, Chair, Department of Family Medicine, Greenville Health System Clinical Associate Professor of Family Medicine, University of South Carolina School of Medicine Greenville Clinical Associate Professor, Clemson University School of Health Research Director of Operations, Department of Family Medicine Greenville Health System Eric Norris, CPA Business Analyst II, Department of Family Medicine Greenville Health System G H S C l i n i c a l U n i v e r s i t y P a r t n e r s
Context: About Us Greenville Health System (GHS) in Upstate, SC Community Hospital Hospital System Integrated Care Delivery System University Medical Group, 7 hospitals, University of South Carolina SOM-Greenville MyHealth First Network (CIN/ACO) GHS, Self Regional Healthcare and 2,000 providers across 11 counties 1,500 physicians and 500 advanced practice providers (APPs) GHS Department of Family Medicine 2 ACGME accredited GME programs FM Residency (7-7-7) PCSM Fellowship (2) FMC NCQA Recognized PCMH 11 core faculty physicians 16 community practices across 5 counties 11 NCQA Recognized PCMHs 46 physicians and 22 APPs
The Problem: Lack of Alignment GHS Mission: Heal compassionately. Teach innovatively. Improve constantly. GHS Vision: Transform health care for the benefit of the people and communities we serve. Faculty Compensation Plan Previous compensation model was not aligned with teaching, research/scholarly activities, quality, resident performance, faculty performance, and team goals Model included Fixed Component (50%) and Net Income Component (50%) Net Income = Collections - Expenses Community-Based Physician Compensation Plan Previous compensation model was Net Income Disparity noted among practices due to payer mix, overhead expenses, and geography Encouraged silo behaviors as opposed to system behaviors Caused difficulty in equitably implementing Departmental and System Initiatives
The Solution: Better Alignment Faculty Compensation Plan Transitioned to Fixed Base Compensation (50 th percentile of MGMA) with Annual Bonus for achieving Departmental and System Initiatives Annual Bonus potential is approximately 10% of Fixed Base Compensation Better alignment between financial incentives and department/system needs, mission and vision Includes both Individual and Team Goals Individual Goals Writing (Journal Publications/Book Chapters) 14% Presentations & Curriculum Development 10% Committee/Task Force/Workgroup Participation 8% Regional/National Committee Participation 8% Community Service 8% Resident Evaluations of Faculty Performance 12% Medical Student Evaluations of Faculty Performance 12% Team Goals ACGME Annual Resident Survey Scores 8% ABFM Board Exam Pass Rate for PGY-3s 8% Quality Metrics (CIN/ACO & PCMH) 12% Total Annual Bonus Potential 100%
The Solution: Better Alignment Community-Based Physician Compensation Plan Transitioned to a Productivity Model (approximately 90% of total compensation) based on actual Work RVUs (wrvus) earned times wrvu Conversion Factor (set at 50 th percentile of MGMA) Includes minimum work standards for patient contact time during the week 36 hours of scheduled patient care + 4 hours administrative time = 1.0 FTE Plus stipends for teaching medical students ($500/week) and supervising NPs/PAs ($15K/year) Plus an Annual Bonus for achieving Departmental and System Initiatives (approximately 10% of total compensation) Better alignment between financial incentives and department/system needs, mission and vision Includes both Individual Goals and Team Goals Individual Goals Meaningful Use 12% CGCAHPS Physician Communication Score 4% MyHealth First Network (CIN/ACO) Participation 8% Quality Metrics (CIN/ACO & PCMH) 24% GHS Computer-Based Training Completion 8% Timely Closing of Patient Encounters (Epic) 8% Team Goals PCMH Quality Improvement Project Participation 12% GHS Employee Satisfaction Survey Participation 8% Budget Control Practice Level 8% Budget Control Department Level 8% Total Annual Bonus Potential 100%
Future State: How Do We Better Align Incentives with IHI Triple Aim Goals? Faculty Compensation Plan No changes discussed yet for FY2017 Community-Based Physician Compensation Plan Current RVU-Based Productivity Model (aligned with Fee For Service) is not well aligned with IHI Triple Aim (Population Health, Patient Experience, and Controlling Costs) Considering a transition to Fixed Base Salary for FY2017 with Annual Bonus for achieving Departmental and System Initiatives that do align with IHI Triple Aim Goals Considering establishing metrics for minimum panel size (ideally risk-adjusted) and productivity standards benchmarked against base salary levels Will continue rewarding performance on measures that do align with ACO/CIN, PCMH, and IHI Triple Aim BUT what should we be measuring, how, how often, and what are best weightings? Can we estimate with reasonable accuracy the impacts of CMS Health Care Payment Learning and Action Network (HCP-LAN) recommendations including MACRA (MIPS & APMs)?